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r�o?'a !N.c90% <br /> X r = 2� SAN . 10AQUIN Environmental Health Department <br /> — COUNTY — <br /> Greatness grows here . <br /> Monitoring Well /Soil Boring Inspection Report <br /> Date : I'l Inspector : i rv, CONSTRUCTION <br /> Facility Addre s : 0v <br /> Well Address : Total Depth : <br /> WP# (� (� �1 �(� (�7 Well # : (� ' Drilling Rig Type : <br /> Soil Boring# : <br /> Drilling Company : ;ES� ('�C�..,L C�h �� �onln�rt, � . Min 2 " Annular EHD Seal Verified : 11 Yes El No <br /> Screen Length From : To : <br /> Driller Onsite : <br /> Consultant : A U LVI(Jl',(1 pip L2L 6 Filter Pack From : To : <br /> Geologist : Bentonite From : To : <br /> Grout From : To : <br /> Public Water System Onsite : ❑ Yes ❑ No COMPLETION ❑ Stove Pipe ❑ Christie Box <br /> Domestic Well Onsite : ❑ Yes El No casing <br /> If yes, location and distance : height <br /> SAMPLING I1BOVE.GROUND <br /> Holding Temperature : COWFLErION COOMP�LETtoN <br /> Method : G=M Sumacs <br /> Screening Method : ofO1t <br /> Verified Chain of Custody : ❑ Yes El No � n' <br /> n. <br /> n. <br /> SPOILS <br /> V - m <br /> Contamination Noted : ❑ Yes ❑ No — r <br /> If yes, spoils storage Location : slotted <br /> axtion _ <br /> Covered : ❑ Yes ❑ No <= <br /> vavol Pack <br /> If yes, material : <br /> GROUTING or DESTRUCTION Ttal Depth :���� <br /> Depth to Water : <br /> l n, � = n. <br /> Grout Material : MATERIALS/ DEVELOPMENT <br /> Gallons of Grout Used : <br /> Casing Type : <br /> ❑ Well Installation ❑ Well Destruction Blank Feet Screen Feet <br /> Slot Size : <br /> ❑ Boring Installation ❑ Boring Destruction Bags iz Cement : <br /> METHOD USED Bags Sand /Gravel : <br /> ❑ Pressure Grout ❑ Over Drill Type/ Brand of Bentonite : <br /> Filter Pack Type/Size : <br /> ❑ Gravity ❑ Tremie ❑ Other : Type of Method : <br /> Water Cement 473Water Cement 94 lb <br /> allons B allons Bags <br /> Thickest Thinnest uBags Thickest Thinnest OBags Bentonite/Cement Mix 3 % Mix 5 % Mix <br /> 2. 5 5 1 5 10 1 Bentonite per 47 Ib 18411 2047 <br /> s 10 2 10 20 z Bentonite per 94 Ib 20821 4 . 7 <br /> 7. 5 15 3 v 15 30 3 <br /> 10 20 4 '// 20 40 4 <br /> 12. 5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17. 5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 1 T 209 468-3420 I F 209 464- 0138 www . sicehd . com <br />